Insurance scheme enhances community members' access to healthcare

Majority of rural community members in Ghana are often unable to obtain the necessary medical treatment outside of the main harvest season because of their inability to pay. To enable sick members to seek care, irrespective of seasonal income cycles, community-based health insurance schemes are being established throughout the country.

The schemes, also known as mutual health organizations, increased rapidly in number from 47 in 2001 to 159 in 2002. Their membership also grew dramatically from 86,822 to 220,401, and the number of new districts initiating the scheme increased from 34 to 67 within the same period. Currently, a third of the schemes are paying the bills of their members and it is remarkable that no health care provider has complained of delays in reimbursements by the schemes. One of such groups is the Nkoranza Community Health Insurance Scheme in the Brong Ahafo Region. It was the first community scheme in the country.

This community initiative to establish health insurance schemes that will provide members with affordable health care is being supported by USAID and other international organizations. USAID, through its Partners for Health Reform (PHRplus) project, is assisting to develop the managerial, financial, and information systems needed to make the scheme function efficiently and effectively. USAID’s technical assistance also helped the scheme to carefully choose its benefit packages and realistic premiums so as to attract more people, sustain the scheme and make it viable. The technical assistance also suggests simple mechanisms for holding management accountable for the use of resources, and organizes regular workshops for the schemes to share ideas and experiences about their operations.

The Nkoranza scheme has expanded to cover the entire district and has 40,603 paid-up members out of a population of 134,236. It has also paid the full cost of admission for 60,000 cases admitted at the local hospital over its eleven years of operation. Nkoranza’s success is demonstrated by the coverage of all bills of their clients without external support and the maintenance of a reasonable annual premium of ¢20,000 for old members and ¢22,000 for new clients.

A 56-year-old member said she no longer has to find a buyer for a goat before seeking health care. Another member credits the improved access to health care with a noticeable decrease in deaths among children in his village. And Kwame, a 14-year old pupil who was on admission at the local hospital expressed his gratitude to his father for paying the annual premium of ¢100,000 for the family to enable him receive prompt treatment at the hospital.